Marisela HERRERA, Luz Sanchez, Nicholas Acosta, Penny Wollmen, individually and on behalf of others similarly situated, Plaintiffs-Appellants, v. JFK MEDICAL CENTER LIMITED PARTNERSHIP, d.b.a. JFK Medical Center, HCA Holdings, Inc., Memorial Healthcare Group, Inc., d.b.a. Memorial Hospital Jacksonville, North Florida Regional Medical Center, Inc., Defendants-Appellees.
No. 15-13253
United States Court of Appeals, Eleventh Circuit.
April 26, 2016.
87 F.Supp.3d 1299
Non-Argument Calendar.
VACATED AND REMANDED.
Walter J. Tache, Thomas John Meeks, Jessica Zagier Wallace, Carlton Fields Jorden Burt, PA, Miami, FL, John D. Emmanuel, Ashley Bruce Trehan, Edward Martin Waller, Jr., Buchanan Ingersoll & Rooney, PC, Tampa, FL, for Defendants-Appellees.
Before MARTIN, JULIE CARNES, and ANDERSON, Circuit Judges.
PER CURIAM:
Plaintiffs brought this putative class action alleging that Defendant HCA Holdings, Inc. and three of its Florida hospitals, Defendants JFK Medical Center, Memorial Hospital Jacksonville, and North Florida Regional Medical Center, Inc. (collectively, “Defendants“), charged unreasonable fees for emergency radiological services, including CT scans, MRIs, ultrasounds, and x-rays. On Defendants’ motion, the district court struck Plaintiffs’ class action allegations, effectively denying class certification. We granted Plaintiffs’ interlocutory appeal. See
I. Background
Under the Florida Motor Vehicle No-Fault Law,
Plaintiffs allege that Defendants charge PIP-covered patients who receive treatment after motor vehicle accidents unreasonable fees for radiological services. In
Specifically, the amended complaint alleges that each plaintiff received a CT scan of his or her brain. Herrera and Sanchez were charged $6,404 at JFK Medical Center in Atlantis, Florida, while Acosta was charged $6,277 at Memorial Hospital Jacksonville and Wollmen was charged $6,140 at North Florida Regional Mеdical Center in Gainesville. Plaintiffs also received CT scans of their spines. Herrera and Sanchez were charged $5,900 each, Acosta was charged $6,965, and Wollmen was charged $6,853. The Florida Medicare rate for a brain CT scan ranges from $164 to $169, and for a CT scan of the cervical spine it ranges from $213 to $220. Defendants charge uninsured patients anywhere from $1,596 to $3,464 for a CT scan. Plaintiffs thus allege that Defendants charged them fees far in excess of what it usually and customarily charges the uninsured or private, non-PIP insurers, including insurers who do not have a contract with Defendants.
As to x-rays, Herrera received a lumbar spine x-ray at a cost of $3,359. Herrera and Sanchez each received a thoracic spine x-ray at a cost of $2,222, and Wollmen received one for $1,454. The Florida Medicare rate for a lumbar spine x-ray is $50, and for a thoracic spine x-ray it is $40. Plaintiffs further allege that the rates they were charged greatly exceeded the amounts typically billed and paid by private, non-PIP insurers or uninsured patients. Plaintiffs contend that all of these rates were unreasonable as a matter of law.
As a result of these fees, Plaintiffs exhausted their $10,000 PIP insurance policies and were left with medical bills that would have been covered in full or in part had Defendants not charged these unreasonable rates. Accordingly, Plaintiffs seek to represent a class of similarly-situated persons who received PIP-covered emergency radiological services at one of Defendants’ hospitals in Florida and who “(a) were billed by the facility for any portion of the charges for such services; and/or (b) had their $10,000 of PIP coverage prematurely exhausted by the facility‘s charges and, as a result, werе billed for additional medical services rendered by the facility and/or third-party providers that would otherwise have been covered under PIP.”
Plaintiffs assert violations of Florida‘s Deceptive and Unfair Trade Practices Act, breach of contract, and breach of the implied covenants of good faith and fair dealing. Defendants moved to dismiss the amended complaint and to strike Plaintiffs’ class allegations. The cоurt dismissed the claim for breach of the implied covenants of good faith and fair dealing, but let the other claims proceed. The court struck the class allegations, however, explaining that “the most important issue to settle, the reasonableness of the charge for the specific radiological service and the damages incurred by each putative plaintiff, would be highly individualized in nature.” Herrera v. JFK Med. Ctr. Ltd. P‘ship, 87 F.Supp.3d 1299, 1308 (M.D.Fla.2015). The court said it would also have to examine whether the expenses Plaintiffs claimed would have been covered by PIP insurance were reasonable, necessary, and re
II. Discussion
We review a district court‘s decisions regarding class certification for abuse of discretion. Vega v. T-Mobile USA, Inc., 564 F.3d 1256, 1264 (11th Cir.2009). “A district court abuses its discretion if it applies an incorrect legal standard, follows improper procedures in making the determination, or makes findings of fact that are clearly erroneous.” Id. (citation omitted).
Federal Rule of Civil Procedure 23 governs class аctions. “A class action may be maintained only when it satisfies all the requirements of [Rule] 23(a) and at least one of the alternative requirements of Rule 23(b).” Allapattah Servs., Inc. v. Exxon Corp., 333 F.3d 1248, 1260 (11th Cir.2003) (quotation marks omitted). Under
- the class is so numerous that joinder of all members is impracticable;
- there are questions of law or fact common to the class;
- the claims or defenses of the representative parties are typical of the claims or defenses of the class; and
- the representative parties will fairly and adеquately protect the interests of the class.
In this case, the relevant alternative requirement is
Plaintiffs argue that the district court erred in two ways: (1) the district court should have allowed discovery before making a decision about predominance, and (2) the district court made its decision primarily on the basis that there would be individualized damages issues, which fact should not necessarily preclude class treat
In Mills v. Foremost Insurance Co., we rеversed a district court‘s decision, based solely on its reading of the complaint, not to certify a class. 511 F.3d at 1307-11. The plaintiffs alleged that a mobile-home insurer did not fully compensate the homeowners for damages caused by a hurricane. Id. at 1302. Because the plaintiffs suffered a wide variety of property damage in the hurricane, and the insurance policies varied, the district court, without conducting discovery, declined tо certify the class. Id. at 1303. We reversed, explaining that this was not the sort of case where it is obvious from the pleadings that the individual issues would overwhelm the common issues. Id. at 1309. The plaintiffs claimed that the common issue was whether defendant failed to compensate them for contractor overhead and profit charges, as well as for taxes they incurred in purchasing materials to repair their hurricane-damaged property. Id. at 1310. On the other hand, the defendant argued that individual issues would predominate because the court would have to determine for each claim “whether the services of a general contractor would be reasonably required under the circumstances,” and “there may be instances in which the insureds, depending on their individual circumstances, might buy materials but incur no sales tax.” Id.
The plaintiffs responded that they could use defendаnt‘s own adjusters’ hurricane-damage estimates to determine whether a general contractor‘s services were reasonably required, or whether sales taxes were reasonably likely to be incurred. Id. The plaintiffs did not dispute these estimates and argued that all they sought was a
Because of these diverging views on the ease of proving the class‘s claims, we held “that the district court‘s conclusion as to the predominance issue at the complaint stage was speculative at best and premature at least.” Id. at 1309-10. Therefore, the district court abused its discretion by finding that class-action treatment was inappropriate based solely on the pleadings. Id. at 1311. We explained that the court should permit limited discovery relevant to the certification issue and then determine whether to hold an evidentiary hearing. Id.3
In this case, the parties similarly present conflicting interpretations of the issues and evidence that would be required to establish liability and damages for the class as a whole. Defendants argue that individual issues predominate because liability cannot be proven on a class-wide basis. To determine liability, they claim that the court would have to look at the reasonableness of the charges for each class member‘s radiological services. But they argue that the reasonableness inquiry is complicated by the fact that different hospitals charge different rates for the same services. According to the PIP statute, the court would have to consider severаl factors to assess reasonableness, namely the “usual and customary charges and payments accepted by the provider involved in the dispute, reimbursement levels in the community and various federal and state medical fee schedules applicable to motor vehicle and other insurance coverages.”
Plaintiffs acknowledge that there are some factual differences regarding each class member‘s claim, such as the specific radiological service received, the hospital where the plaintiff was treated, and the total amount billed for these services. But Plaintiffs argue that their theory of liability is that Defendants, across the board, charged unreasonable rates for emergency radiological services to PIP patients. And they did so because Defendant HCA, the parent company of the defendant hospitals, directed the hospitals to charge rates that greatly exceeded any standard of reasonableness under the PIP statute. While the rates varied from hospital to hospital, Plaintiffs argue that the fees were many times greater than the Florida Medicare rates for the same services, thus easing problems with determining reasonableness.4 For example, Defendants charged between $5,900 and $6,965 for spinal CT scans. Because Medicare rates for this service are between $213 and $220, and
Plaintiffs also argue that, to the extent there are individualized damages issues, common issues nevertheless predominate. Defendants respond that the district court would have to analyze whether a class member‘s PIP insurance was exhausted, whether that member had coinsurance that would have covered additional expenses, and whether those charges were reasonable and related to the motor vehicle accident.
“[T]he presence of individualized damages issues does not prevent a finding that the common issues in the case predominate.” Allapattah Servs., Inc. v. Exxon Corp., 333 F.3d 1248, 1261 (11th Cir.2003).5 Typically, even if courts must confront some individualized damages issues, common issues predominate if liability can be determined on a class-wide basis. See id.; cf. Klay v. Humana, Inc., 382 F.3d 1241, 1260 (11th Cir.2004) (“It is primarily when there are significant individualized questions going to liability that the need for individualized assessments of damages is enough to preclude 23(b)(3) certification.“), abrogated in part on other grounds by Bridge v. Phoenix Bond & Indem. Co., 553 U.S. 639 (2008).
We recognize that damages calculations will vary from person to person. But at least at the pleading stage, we cannot say that this is an “extreme case[] in which computation of each individual‘s damages will be so complex, fact-specific, and difficult that the burden on the court would be simply intolerable.” Klay, 382 F.3d at 1260. In short, we find that this case is analogous to Mills v. Foremost Insurance Co. because discovery is needed to determine whether common issues predominate over any individualized questions.
We emphаsize that nothing in our opinion should be read to suggest how the district court should ultimately rule on the certification decision. We hold only that the district court should have allowed limited discovery instead of striking the class allegations based solely on the face of the complaint.6
For all the above reasons, we reverse the district court‘s decision to strike the class allegations from Plaintiffs’ amended complaint and remаnd for further proceedings consistent with this opinion.
REVERSED and REMANDED.